The Functional Group Model

The Functional Group ModelKatelyn Darrenkamp, Gretchen Kempf, Maria Licitra, Lauren Patire, Colleen Sullivan, Tara Wisbauer

Dr. Sharan Schwartzberg ObjectivesIntroduce the focus and theory of the Functional Group Model

Give insight to using the Functional Group Mode to guide intervention

Provide research that support this model

Present an assessment that is congruent with the Functional Group Model

Introduce and discuss a case study that describes and gives insight about the functional use of this model in occupational therapy

Development Created by: Dr. Sharon SchwartzbergCo-founders: Margot Howe, Mary Barnes

First introduced in 1986

Used in physical disability settings

Dr. Schwartzberg currently works at Tufts University in Boston, MAThe Focus of the ModelDiscussion and group dynamics to resolve intrapersonal and interpersonal difficulties.

Developing communication and interaction skills to enhance occupational performance.

Group of people interacting together in order to achieve a common aim or purpose.

The Focus of the ModelFocus on purposeful activity and the act of doingAction orientedFour action components: PurposefulSelf-initiatedSpontaneousGroup-centeredThe Focus of the ModelAdvantages of groupsNatural context for addressing clients interpersonal problems

Social Support

Clients can share relevant knowledge and experiences

The Focus of the ModelGroups characterizedStructure CohesionStages of developmentFormationBuilding relationshipsDeciding aims and proceduresAccomplishing tasksTerminating

the organization and procedure of the groupThe Focus of the ModelCharacteristics of a true groupInteraction among membersShare one common goalRelationship between size and functionMembers desire to be part of the groupSelf-determination

Centennial Vision (OT MONTH )Widely recognized professionUsed throughout different practice areasDeveloped and researched by an OTMeeting societys occupational needsActivities and group is suppose to be seen as relevant to the clients needs, goals and life roles.Evidence-BasedEvidence supporting the successfulness of the modelTheoryConceptsAdaptation- the adjustment of the organism to its environment or the process by which it adjustsOccupation- also referred to as action

TheoryPrinciples:Groups encompass a common goal and dynamic interaction of their membersGroups has capacity for self-directionGroups can become increasingly independent of designated leadership Groups can address individual needsGroups provide multiple types of feedback and supportGroups can support members growth and change How Does it Frame Problems and Challenges?Frames the clients problems in a here-now realityElicit growth and changeAll members can contribute toward a common goal or taskThe challenges are given a place to provide function in the reality to learn skills, and address themThis model puts challenges in a functional position and the client is expected to respond to environmental expectations

What Does Intervention Focus On?The focus of intervention is the use of the four action components purposeful, self-initiated, spontaneous, and group-centered action and tasks to support member's achievement of desired goals and for ultimate group success. Intervention involves: the development of a plan, selection of group members and methods, and planning the structure of the group and its tasks. The role and encouragement of the therapist is of critical importance to the intervention and group success. During intervention, the therapist takes appropriate leadership action and conducts assessments

Intervention The design of the functional group is importantThe following factors should be considered and achieved in planning, running, and reviewing the group for success: Maximum involvement through group-centered actionA maximum sense of individual and group identity A flow experienceSpontaneous involvement of membersMember support and feedback Plan may have to be adapted throughout the various phases of the group development.

Levels of Group Development Each level represents an increasingly cohesive, balanced, and self-determining groupParallel groupsProject groupsEgocentric cooperative groupsCooperative groups -Identified by Mosey (1970)

Research that Supports the ModelMost research deals with how to do groups, how to manipulate the variables, and how to get the best results from group intervention.

Strong Evidence in regards to: Group size and interaction Cohesiveness and effectiveness of intervention Choice and control, when a group has client-centered goals, there is greater client satisfaction and participation Group composition and cohesiveness Groups with members with similar performance skills, goals, and abilities have increased participation in groups Research Studies: (Schwartz & Schwartzberg, 2011) Two types of psychodynamic groups were developed for a population of elders with depressive disorders: a verbal group and an activity group.The verbal group focused on working through experiences, exploring feelings, maladaptive patterns, self-understanding, and interpersonal relationships. The activity group had four major characteristics: Purposeful actionSelf-initiated actionSpontaneous (here and now) actionGroup-centered action Research Studies: (Schwartz & Schwartzberg, 2011) ContdAzima and Azima (1959) stated that the difference between activity groups and verbal groups are that in activity groups, the person is able to verbalize and do things to objects.Participating in activities can evoke unconscious reactionsModalities in an activity group include arts and crafts, music, cooking, gardening, etc.Verbal groups found that therapists needed a lot of energy to spark initiation for older adults with depressionConclusions:Therapists need to adapt the groups as necessary to the groups needs.Therapists may find one approach better than another. As people lose functional capacity in one area, they may find strengths in another. Research Studies: (McDermott, 2008)Activity-based, awareness-oriented verbal groups were found to be more effective than purely verbal groups for developing interpersonal skills (DeCarlo & Mann, 1985; Mumford, 1974).Parallel task groups, compared to activity-based verbal groups, had more interactions between members, and less non-communicating members (Schwartzberg, Howe, & McDermott, 1982). The authors of this study found that task groups, compared to verbal groups and activity-based verbal groups, had positive outcomes on patient interaction.High amount of peer interactionLow number of members not communicating activelyPromotion of social skills, perhaps due to the natural, comfortable, and non-threatening environment and exchange of interaction during task group

Research Studies: (Schwartzberg, Trudeau, & Vega, 2013)There is a need to assess group outcomes to prove the worth of group intervention in occupational therapy.Authors of this article suggest ways in which future researchers could assess outcomes in group intervention: By measuring the impact intervention has on the patientThrough assessments that are sensitive to change to track differences in progressOne rater-completed and one patient-completed instrument to ensure desired group outcomes Whats to Come in Research Evidence of higher quality: Such as randomized control trial studyComparing Functional Group Model to another modelMeasure of fidelity to Functional Group Model

Assessment: Group Leader Self-Assessment (GLSA) (Barnes, 2011)

Assessments: Evidence Group Leader Self-Efficacy Instrument 36 Item Instrument Participants were 204 counselor trainees - diverse, 30 universities in 20 statesItems with >.40 on factor analysis were kept (ended up losing 1 item) Validity and Reliability Studies Found: Construct Validity supported Reliability:Cronbachs alpha for the consistency of items on test = .75, high internal consistency Test-Retest at 2 week intervals, found to be acceptable Assessment: Group Leader Self-Assessment (GLSA) (Barnes, 2011) Items are adapted from Page, Pietrzack, & Lewis (2001)Article is a guideFor developing items in relation to leaders self-efficacy in group leadership.Barnes adapted 4 Items from the Study: Items include the self-perceived ability of the leader:To be supportive and caringProvide executive functions, Provide emotional stimulationProcess experiences. Barnes also utilizes the same 6 Point Likert ScaleRated from 1 being strongly disagree to 6 being strongly agree.

Group Leader Assessment Strengths:Easy to use Structured and organizedEvidence that supports each areaContinued and updated research

Weakness:Self-assessment

Case Study Name of Group: Community Re-entry: Moving ForwardLeaders: 1 OT, 1 COTATime/length of meetings: 4X week, 90 mins eachGroup format: ClosedShort-Term Group GoalsTo describe abilities and strengths. To be able to select, perform, and coordinate activity schedule to maintain a balance between rest and work. To be able to position self physically to promote optimal safety and life roles. Identify a peer support network in the community to aid adjustment to disability

Long-Term Group Goals Identify changes regarding the result of current disability status in order to perform aspects of meaningful rolesIdentify changes in living environment and relationships necessary for adaptation to current disability. Identify potential barriers to adjustment to community living and discuss strategies for intervening with identified barriersUse joint protection and/or body mechanic principles to minimize stress on joints and prevent falls or further injuryRationale For Use of Functional Group ModelThe members of the group are dealing with community re-entry and changes in life roles, which may include asking others to fulfill some needs.It is also recognized that members are expected to meet criteria for functional performance at discharge. Clients need strategies and support to maintain themselves physically, emotionally, and socially in the community and to continue to achieve a maximum level of functioning. Patient education is necessary to prevent further debilitation/ disability. Ideas for Intervention?InterventionSession 1: Intro to group: purpose, goals, procedures, and ice-breakers Session 2: Individual collages: What I Value, discussion Session 3: The Pie of My Life pre-hospitalization and post-hospitalization Expressive Art Activity, group discussion Session 4: Energy conservation, pain management, lecture slide-show demonstration, group discussionSession 5: Time management principles and discussionSession 6: Dealing with human and architectural barriers, and identifying community resources with handouts and discussionSession 7: Community integration at home/work/sociallySession 8: Group closure References American Occupational Therapy Association. (2007). Centennial Vision.http://www.aota.org/ AboutAOTA/Centennial-Vision.aspxBarnes, M. A. (2011). Group Leader Self Assessment (GLSA). Unpublished tool, Tufts University, Medford, MA.Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice. (4th ed.). F.A. Davis: PhiladelphiaMcDermott, A. (2008). The effect of three group formats on group interaction patterns. Occupational Therapy in Mental Health, 8(3), 69-89.Page, B. J., Pietrzak, D. R., & Lewis, T. F. (2001). Development of the group leader self-efficacy Instrument. Journal for Specialists in Group Work, 26, 168-184.

Hey Lauren, is this the citation for the book we are using? .... Howe, M. C., & Schwartzberg, S. L. (1995). A functional approach to group work in occupational therapy. Philadelphia: JB Lippincott.Hi Maria, its on the next page, Schwartzberg, Howe, Barnes (2008)oh ok thanks!!I'm done with my case study slides.... any thoughts?Looking goods, did you have the handouts typed up as well?Yes I just need to update that reference, but I can print them out, no probOk awesome!Can i save the slides to put the pictures on and everything? You're all set?Yes!! I am, and we def need the pics to make it look more exciting. :)Thanks Lauren!No problem! Cant wait to be done!References Schwartz, K., & Schwartzberg, S. L. (2011). Psychodynamically informed groups for elders: A comparison of verbal and activity groups. GROUP Journal of the EasternGroup Psychotherapy Society, 35(1), 17-31. Schwartzberg, S.L., Howe, M.C., & Barnes, M.A. (2008). Groups applying the Functional Group Model. Philadelphia: FA Davis.Schwartzberg, S. L., Trudeau, S., & Vega, V. (2013). Principles of OccupationalTherapy Group Outcomes Assessment in Mental Health. Occupational Therapy in Mental Health: A Journal of Psychosocial Rehabilitation and Research, 29(2), 134-148.